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https://www.readbyqxmd.com/read/29452598/7-versus-14-days-of-antibiotic-treatment-for-critically-ill-patients-with-bloodstream-infection-a-pilot-randomized-clinical-trial
#1
Nick Daneman, Asgar H Rishu, Ruxandra Pinto, Pierre Aslanian, Sean M Bagshaw, Alex Carignan, Emmanuel Charbonney, Bryan Coburn, Deborah J Cook, Michael E Detsky, Peter Dodek, Richard Hall, Anand Kumar, Francois Lamontagne, Francois Lauzier, John C Marshall, Claudio M Martin, Lauralyn McIntyre, John Muscedere, Steven Reynolds, Wendy Sligl, Henry T Stelfox, M Elizabeth Wilcox, Robert A Fowler
BACKGROUND: Shorter-duration antibiotic treatment is sufficient for a range of bacterial infections, but has not been adequately studied for bloodstream infections. Our systematic review, survey, and observational study indicated equipoise for a trial of 7 versus 14 days of antibiotic treatment for bloodstream infections; a pilot randomized clinical trial (RCT) was a necessary next step to assess feasibility of a larger trial. METHODS: We conducted an open, pilot RCT of antibiotic treatment duration among critically ill patients with bloodstream infection across 11 intensive care units (ICUs)...
February 17, 2018: Trials
https://www.readbyqxmd.com/read/29451516/-evidence-based-medicine-vs-personalized-medicine
#2
Lucio Capurso
Evidence-based medicine (EBM) and personalized medicine (PM) are driven by two diverse modes of reasoning about «evidence making». EBM has been criticized since his quality mark has been misappropriated by vested interests, the benefits statistically significant may be marginal in clinical practice, rigid rules and technology may produce care that is management driven rather than patient centered. On the contrary PM (or "precision medicine") refers to the tailoring of medical treatment to the specific characteristics of each patient involving the ability to classify individuals into subpopulations that are uniquely susceptible to a specific treatment, sparing expense and side effects and is derived from doubts on the results of subgroup analyses and on non responders in clinical trials typical of EBM...
January 2018: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/29450530/screening-for-ovarian-cancer-updated-evidence-report-and-systematic-review-for-the-us-preventive-services-task-force
#3
Jillian T Henderson, Elizabeth M Webber, George F Sawaya
Importance: Ovarian cancer is relatively rare but the fifth-leading cause of cancer mortality among United States women. Objective: To systematically review evidence on benefits and harms of ovarian cancer screening among average-risk women to inform the United States Preventive Services Task Force. Data Sources: MEDLINE, PubMed, Cochrane Collaboration Registry of Controlled Trials; studies published in English from January 1, 2003, through January 31, 2017; ongoing surveillance in targeted publications through November 22, 2017...
February 13, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29449963/the-nsight1-randomized-controlled-trial-rapid-whole-genome-sequencing-for-accelerated-etiologic-diagnosis-in-critically-ill-infants
#4
Josh E Petrikin, Julie A Cakici, Michelle M Clark, Laurel K Willig, Nathaly M Sweeney, Emily G Farrow, Carol J Saunders, Isabelle Thiffault, Neil A Miller, Lee Zellmer, Suzanne M Herd, Anne M Holmes, Serge Batalov, Narayanan Veeraraghavan, Laurie D Smith, David P Dimmock, J Steven Leeder, Stephen F Kingsmore
Genetic disorders are a leading cause of morbidity and mortality in infants in neonatal and pediatric intensive care units (NICU/PICU). While genomic sequencing is useful for genetic disease diagnosis, results are usually reported too late to guide inpatient management. We performed an investigator-initiated, partially blinded, pragmatic, randomized, controlled trial to test the hypothesis that rapid whole-genome sequencing (rWGS) increased the proportion of NICU/PICU infants receiving a genetic diagnosis within 28 days...
2018: NPJ Genomic Medicine
https://www.readbyqxmd.com/read/29445502/long-term-recovery-following-critical-illness-in-an-australian-cohort
#5
Kimberley J Haines, Sue Berney, Stephen Warrillow, Linda Denehy
Background: Almost all data on 5-year outcomes for critical care survivors come from North America and Europe. The aim of this study was to investigate long-term mortality, physical function, psychological outcomes and health-related quality of life in a mixed intensive care unit cohort in Australia. Methods: This longitudinal study evaluated 4- to 5-year outcomes. Physical function (six-minute walk test) and health-related quality of life (Short Form 36 Version 2) were compared to 1-year outcomes and population norms...
2018: Journal of Intensive Care
https://www.readbyqxmd.com/read/29444787/randomised-controlled-pragmatic-clinical-trial-evaluating-the-effectiveness-of-a-discharge-follow-up-phone-call-on-30-day-hospital-readmissions-balancing-pragmatic-and-explanatory-design-considerations
#6
Maame Yaa A B Yiadom, Henry Domenico, Daniel Byrne, Michele Marie Hasselblad, Cheryl L Gatto, Sunil Kripalani, Neesha Choma, Sarah Tucker, Li Wang, Monisha C Bhatia, Johnston Morrison, Frank E Harrell, Tina Hartert, Gordon Bernard
INTRODUCTION: Hospital readmissions within 30 days are a healthcare quality problem associated with increased costs and poor health outcomes. Identifying interventions to improve patients' successful transition from inpatient to outpatient care is a continued challenge. METHODS AND ANALYSIS: This is a single-centre pragmatic randomised and controlled clinical trial examining the effectiveness of a discharge follow-up phone call to reduce 30-day inpatient readmissions...
February 14, 2018: BMJ Open
https://www.readbyqxmd.com/read/29444696/bedside-analysis-of-the-sublingual-microvascular-glycocalyx-in-the-emergency-room-and-intensive-care-unit-the-glyconurse-study
#7
Alexandros Rovas, Alexander-Henrik Lukasz, Hans Vink, Marc Urban, Jan Sackarnd, Hermann Pavenstädt, Philipp Kümpers
BACKGROUND: Deterioration of the endothelial glycocalyx (eGC), a protective carbohydrate-rich layer lining the luminal surface of the endothelium, plays a key role in vascular barrier dysfunction and eventually organ-failure in systemic inflammatory response syndrome and sepsis. Early detection of glycocalyx damage could thus become an important goal in critical care. This study was designed to determine the feasibility and reproducibility of quantitative, real-time glycocalyx measurements performed at bedside in the emergency room (ER) and intensive care unit (ICU)...
February 14, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29443725/pediatric-anesthesia-after-the-anaesthesia-practice-in-children-observational-trial-study-who-should-do-it
#8
Walid Habre
PURPOSE OF REVIEW: This review highlights the requirements for harmonization of training, certification and continuous professional development and discusses the implications for anesthesia management of children in Europe. RECENT FINDINGS: A large prospective cohort study, Anaesthesia PRactice In Children Observational Trial (APRICOT), revealed a high incidence of perioperative severe critical events and a large variability of anesthesia practice across 33 European countries...
February 12, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29441518/haloperidol-for-delirium-in-critically-ill-patients-protocol-for-a-systematic-review
#9
M Barbateskovic, S R Kraus, M O Collet, O Mathiesen, J C Jakobsen, A Perner, J Wetterslev
BACKGROUND: In the intensive care unit, the prevalence of delirium is high. Delirium has been associated with morbidity and mortality including more ventilator days, longer intensive care unit stay, increased long-term mortality, and cognitive impairment. Thus, the burden of delirium for patients, relatives, and societies is considerable. The objective of this systematic review was to critically access the evidence of randomised clinical trials on the effects of haloperidol vs. placebo or any other agents for delirium in critically ill patients...
February 14, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29441512/left-atrial-appendage-occlusion-consensus-document-of-association-of-cardiovascular-interventions-and-heart-rhythm-section-of-polish-cardiac-society
#10
Marek Grygier, Wojtek Wojakowski, Grzegorz Smolka, Marcin Demkow, Wojtek Wąsek, Danuta Sorysz, Paweł Kralisz, Krzysztof Bartuś, Adam Sukiennik, Radosław Pracoń, Adam Witkowski, Oskar Kowalski, Jacek Legutko
Left atrial appendage (LAA) occlusion devices have the potential to influence the clinical approach to stroke prevention in patients with atrial fibrillation. A number of percutaneous techniques have been proposed, including various intracardiac plugs and also external ligation. Several devices have been already used in Poland. One of them has been evaluated in randomised controlled trials compared with the current standard of care. Others are less well studied but quite commonly used in Europe. It is anticipated that the use of LAA occlusion technologies in clinical practice will expand...
February 14, 2018: Kardiologia Polska
https://www.readbyqxmd.com/read/29439083/psychological-outcomes-following-a-nurse-led-preventative-psychological-intervention-for-critically-ill-patients-poppi-protocol-for-a-cluster-randomised-clinical-trial-of-a-complex-intervention
#11
Alvin Richards-Belle, Paul R Mouncey, Dorothy Wade, Chris R Brewin, Lydia M Emerson, Richard Grieve, David A Harrison, Sheila Harvey, David Howell, Monty Mythen, Zia Sadique, Deborah Smyth, John Weinman, John Welch, Kathryn M Rowan
INTRODUCTION: Acute psychological stress, as well as unusual experiences including hallucinations and delusions, are common in critical care unit patients and have been linked to post-critical care psychological morbidity such as post-traumatic stress disorder (PTSD), depression and anxiety. Little high-quality research has been conducted to evaluate psychological interventions that could alleviate longer-term psychological morbidity in the critical care unit setting. Our research team developed and piloted a nurse-led psychological intervention, aimed at reducing patient-reported PTSD symptom severity and other adverse psychological outcomes at 6 months, for evaluation in the POPPI trial...
February 8, 2018: BMJ Open
https://www.readbyqxmd.com/read/29438178/treatment-of-pancreatic-cancer-with-intravenous-vitamin-c-a-case-report
#12
Jeanne A Drisko, Oscar K Serrano, Lisa R Spruce, Qi Chen, Mark Levine
Pancreatic ductal adenocarcinoma (PDA) has a dismal prognosis and is often discovered at an advanced stage with few therapeutic options. Current conventional regimens for PDA are associated with significant morbidity, decreased quality of life, and a considerable financial burden. As a result, some patients turn to integrative medicine therapies as an alternate option after a diagnosis of PDA. Intravenous pharmacologic ascorbic acid (PAA) is one such treatment. The use of PAA has been passionately debated for many years, but more recent rigorous scientific research has shown that there are significant blood concentration differences when ascorbic acid is given parenterally when compared to oral dosing...
February 12, 2018: Anti-cancer Drugs
https://www.readbyqxmd.com/read/29437074/letting-the-patient-decide-a-case-report-of-self-administered-sedation-during-mechanical-ventilation
#13
Breanna Hetland, Sarah Maryon Hayes, Debra Skaar, Mary Fran Tracy, Craig R Weinert, Linda Chlan
It is common for critical care nurses to administer sedative medications to patients receiving mechanical ventilation. Although patient-controlled analgesia is frequently used in practice to promote effective self-management of pain by patients, it is not known if patient-controlled sedation can be used to promote effective self-management of distressing symptoms associated with mechanical ventilation. A randomized pilot trial was conducted to evaluate whether patient self-administered sedation with dexmedetomidine is safe and acceptable for self-management of anxiety during ventilator support...
February 2018: Critical Care Nurse
https://www.readbyqxmd.com/read/29435329/use-of-diaphragm-thickening-fraction-combined-with-rapid-shallow-breathing-index-for-predicting-success-of-weaning-from-mechanical-ventilator-in-medical-patients
#14
Pattarin Pirompanich, Sasithon Romsaiyut
Background: Weaning failure is a crucial hindrance in critically ill patients. Rapid shallow breathing index (RSBI), a well-known weaning index, has some limitations in predicting weaning outcomes. A new weaning index using point-of-care ultrasound with diaphragmic thickening fraction (DTF) has potential benefits for improving weaning success. The aim of this study was to evaluate the efficacy of a combination of DTF and RSBI for predicting successful weaning compared to RSBI alone. Methods: This prospective study enrolled patients from the medical intensive care unit or ward who were using mechanical ventilation and readied for weaning...
2018: Journal of Intensive Care
https://www.readbyqxmd.com/read/29432719/a-systematic-review-of-contraceptive-continuation-among-women-living-with-hiv
#15
Catherine S Todd, Tracy C Anderman, Sarah Long, Landon Myer, Linda-Gail Bekker, Greg E Petro, Heidi E Jones
BACKGROUND: Women living with HIV (WLHIV) experience high rates of unmet contraceptive need and unintended pregnancy. Contraceptive method-specific continuation rates and associated factors are critical for guiding providers tasked with both reproductive health (RH) and HIV care. We conducted this systematic review to determine whether contraceptive continuation rates differ between WLHIV and uninfected women and, for WLHIV, whether differences are impacted by method type, antiretroviral therapy (ART) use, or other factors...
February 9, 2018: Contraception
https://www.readbyqxmd.com/read/29432589/changing-change-adaptations-of-an-evidence-based-telehealth-cardiovascular-disease-risk-reduction-intervention
#16
Leah L Zullig, Felicia McCant, Mina Silberberg, Fred Johnson, Bradi B Granger, Hayden B Bosworth
Relatively few successful medication adherence interventions are translated into real-world clinical settings. The Prevention of Cardiovascular Outcomes in African Americans with Diabetes (CHANGE) intervention was originally conceived as a randomized controlled trial to improve cardiovascular disease-related medication adherence and health outcomes. The purpose of the study was to describe the translation of the CHANGE trial into two community-based clinical programs. CHANGE 2 was available to Medicaid patients with diabetes and hypertension whose primary care homes were part of a care management network in the Northern Piedmont region of North Carolina...
February 8, 2018: Translational Behavioral Medicine
https://www.readbyqxmd.com/read/29431016/assessment-and-management-of-constipation-for-patients-receiving-palliative-care-in-specialist-palliative-care-settings-a-systematic-review-of-the-literature
#17
Deborah Hl Muldrew, Felicity Hasson, Emma Carduff, Mike Clarke, Jo Coast, Anne Finucane, Lisa Graham, Philip Larkin, Noleen K McCorry, Paul Slater, Max Watson, Eileen Wright, Sonja McIlfatrick
BACKGROUND: Constipation is an important issue for patients receiving palliative care within specialist palliative care settings. Questions and ambiguity, however, persist about international best practice and management. AIM: To synthesise the current evidence base on the assessment and management of constipation for palliative care patients within a specialist palliative care setting. DESIGN: This is a systematic review. DATA SOURCES: MEDLINE, Embase, CINAHL, Scopus and Cochrane databases were systematically searched in April 2017 for empirical studies, written in English, on the assessment and management of constipation in specialist palliative care settings, published between 2007 and 2017...
February 1, 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29430845/peer-counselling-versus-standard-of-care-on-reducing-high-risk-behaviours-among-newly-diagnosed-hiv-positive-men-who-have-sex-with-men-in-beijing-china-a-randomized-intervention-study
#18
Yu Liu, Sten H Vermund, Yuhua Ruan, Hongjie Liu, K Rivet Amico, Jane M Simoni, Bryan E Shepherd, Yiming Shao, Han-Zhu Qian
INTRODUCTION: Reducing high-risk behaviours (i.e. multiple partnership, condomless anal/vaginal sex, alcohol use before sex, illicit drug use) after HIV diagnosis is critical for curtailing HIV transmission. We designed an intervention to explore peer- counselling in reducing high-risk behaviours among newly diagnosed HIV-positive Chinese men who have sex with men (MSM). METHODS: We randomized 367 newly diagnosed HIV-positive men to either standard-of-care (SOC; n = 183) or peer-counselling intervention (n = 184), and followed them for 12 months (visit at 0-, 3-, 6-, 9- and 12-month)...
February 2018: Journal of the International AIDS Society
https://www.readbyqxmd.com/read/29430558/therapeutic-angiogenesis-for-peripheral-artery-disease-lessons-learned-in-translational-science
#19
Sunil R Iyer, Brian H Annex
Peripheral arterial disease (PAD) is a major health care problem. There have been limited advances in medical therapies, and a huge burden of symptomatic patients with intermittent claudication and critical limb ischemia who have limited treatment options. Angiogenesis is the growth and proliferation of blood vessels from existing vasculature. For approximately 2 decades, "therapeutic angiogenesis" has been studied as an investigational approach to treat patients with symptomatic PAD. Despite literally hundreds of positive preclinical studies, results from human clinical studies thus far have been disappointing...
October 2017: JACC. Basic to Translational Science
https://www.readbyqxmd.com/read/29428919/randomized-control-trial-comparing-pain-control-interventions-in-preterm-neonates
#20
Vivek V Shukla, Satvik Bansal, Archana Nimbalkar, Apurva Chapla, Ajay Phatak, Dipen Patel, Somashekhar Nimbalkar
OBJECTIVE: To compare individual efficacy and additive effects of pain control interventions in preterm neonates. DESIGN: Randomized controlled trial. SETTING: Level-3 University affiliated neonatal intensive care unit. PARTICIPANTS: 200 neonates (26-36 weeks gestational age) requiring heel-stick for bedside glucose assessment. Exclusion criteria were neurologic impairment and critical illness precluding study interventions...
February 9, 2018: Indian Pediatrics
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